347005239-11-8-2022-27-AS-KHOS-CKZJGY-20221109060307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005239
Report Date: 11/04/2022
Date Signed: 11/08/2022 02:00:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220817171650

FACILITY NAME:	GREENHAVEN ESTATES		FACILITY NUMBER:	347005239
ADMINISTRATOR:	MALISSA ACUNA		FACILITY TYPE:	740
ADDRESS:	7548 GREENHAVEN DR		TELEPHONE:	(916) 427-8887
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	105	CENSUS: 52	DATE:	11/04/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Kayla Davis		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not receive training on MC unit
Staff did not recieve training on AL unit
Residents did not receive food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to deliver complaint investigation findings. LPA met with Administrator Kayla Davis, and explained the purpose of the visit.

The department has determined the following as it relates to the allegations: Staff did not receive training on the MC unit, staff did not received training on the AL unit, and residents did not receive food.

LPA Valerio interviewed 8 staff members. According to 7 out of 8 interviews, staff stated they have been trained on both sides. Previous Administrator Malissa Acuna stated that the facility was in the middle of cross training all the staff to ensure all staff know how to work on the memory care unit side and assisted living side. The facility wanted to go in this direction to avoid being short staff in the event staff call-outs occur. According to staff interviews, staff undergo an extensive amount of Relias training and go through in-person training before being allowed to go on the floor alone.
Continues on LIC 9099 - C...
This report was amended to change from confidential to a public document.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20220817171650

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GREENHAVEN ESTATES	FACILITY NUMBER: 347005239
	VISIT DATE: 11/04/2022

NARRATIVE

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Continued from LIC 9099

According to the previous administrator, the facility has a stipulation order in place where the facility must meet the requirement of 40 annual hours in addition to weekly, monthly, and quarterly trainings. According to all staff interviews, zero staff stated that a resident has not received food. Staff reported that the only time a resident does not get food is when they do not want to eat a meal. Staff report that a meal is always offered, whether it is in the dining hall or directly to their room.

LPA interviewed 4 residents and 1 family member. 1 out of 4 interviews with residents were unsuccessful. 3 out of 4 residents stated they have received all their meals. Two residents reported that staff come to the residents room to come down for their meals. According to an interview with a family member, the family member stated they visit frequently and have seen improvements over the year and stated the staff are more interactive than before.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held, and a copy of report was given to Administrator Kayla Davis.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC9099 (FAS) - (06/04)

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